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Complete or total glossectomy is a surgical procedure primarily performed to treat cancer of the tongue. This procedure involves the extensive removal of the tongue, specifically more than one-half or an entire side of it, which is critical in managing malignancies that affect this area. In cases where a tracheostomy is deemed necessary, the surgeon makes a vertical or horizontal incision in the neck, typically over the cricoid cartilage, to facilitate airway access. The procedure requires careful dissection through the platysma muscle to reach the midline raphe between the strap muscles, which are then separated to expose the pretracheal fascia and the thyroid isthmus. The thyroid isthmus is subsequently divided to allow for further access. If a tracheostomy is performed, the trachea is incised, and a tracheostomy tube is inserted and secured to ensure the patient’s airway remains open during and after the procedure. Following this, an incision is made under the mandible to access the floor of the mouth, where the mandible may be split to facilitate the removal of the tongue along with a margin of healthy tissue to ensure complete excision of cancerous cells. The surgical site is then closed using primary sutures, although alternative methods such as skin grafts or free flap grafts may be employed for reconstruction. The mandible is wired together to stabilize the area, and the incision is closed with drains placed to manage any postoperative fluid accumulation. This procedure is distinct from other related surgeries, such as the one described in CPT® Code 41145, which includes a unilateral radical neck dissection in addition to the glossectomy.
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The complete or total glossectomy is indicated for patients diagnosed with cancer of the tongue. This procedure is typically recommended when the malignancy involves more than one-half of the tongue or necessitates the removal of an entire side of the tongue to achieve clear margins and ensure comprehensive treatment of the cancerous tissue.
The procedure begins with the surgeon making a vertical or horizontal incision in the neck over the cricoid cartilage if a tracheostomy is required. This incision allows for the removal of subcutaneous fat using electrocautery, followed by dissection through the platysma muscle to reach the midline raphe between the strap muscles. The strap muscles are then separated to expose the pretracheal fascia and the thyroid isthmus, which is subsequently divided to facilitate access to the trachea. An incision is made in the trachea, and a tracheostomy tube is inserted and secured to maintain an open airway. After establishing the airway, the surgeon makes an incision in the lower jaw beneath the mandible, allowing for the mandible to be split to gain access to the floor of the mouth. The complete or total glossectomy is then performed, involving the removal of the entire tongue or a significant portion of it, along with a margin of healthy tissue to ensure all cancerous cells are excised. Once the glossectomy is completed, the surgical defect may be closed with primary sutures, or alternatively, a separately reportable skin graft or free flap graft may be utilized for reconstruction. The mandible is then wired together to stabilize the area, and the incision is closed with drains placed to manage any postoperative fluid accumulation.
Post-procedure care for a complete or total glossectomy includes monitoring the patient for any complications related to the surgery, such as infection or airway obstruction due to the tracheostomy. Patients may require assistance with breathing and swallowing, and they will be closely observed in a postoperative setting. Pain management is essential, and the surgical site will need to be kept clean and dry. Follow-up appointments are necessary to assess healing and to determine if any additional treatments, such as radiation or chemotherapy, are required. The patient may also need speech therapy to aid in recovery of speech and swallowing functions.
| Short Descr | REMOVAL OF TONGUE | Medium Descr | GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ | Long Descr | Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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